The Centers for Medicare & Medicaid Services (CMS) is proposing two policy changes aimed at creating a new payment framework for software-based diagnostic tools that becoming increasingly common in health care.
What’s proposed:
- A new payment pathway for “Software as a Medical Service” (SaMS), including certain algorithm-driven diagnostic and clinical decision-support tools.
- Moving certain software-based analyses performed on existing laboratory data from the Clinical Laboratory Fee Schedule (CLFS) to the Outpatient Prospective Payment System (OPPS).
CMS’ position: The agency says current payment systems were designed around traditional services and laboratory testing, making it difficult to consistently value software-driven technologies.
Why it’s drawing attention: Some of the affected services are currently paid through the CLFS. CMS argues that standalone algorithmic analyses should instead be treated like other software-based diagnostic services.
What’s next: CMS is seeking public comment as it considers a longer-term payment strategy for these technologies.
Go deeper: Review the CMS proposed rule summary